Wherein a surgeon tells some stories, shares some thoughts, and occasionally shoots off his mouth. Like a surgeon.

Monday, September 04, 2006

Breast Cancer: scary tales

Here is a truism by which I've always stood in my breast practice: an excellent way to investigate a palpable (feelable) breast lump is "fine needle aspiration." In fact, I'm a bit of a fanatic about it: I think gazillions of dollars are wasted by unnecessary breast ultrasounds for lumps, and by more extensive biopsies than -- in many cases -- are needed. I'm happy to say I was a bit of a burr under the saddle to many a radiologist, and some primary care docs as well, as I tried to spread the word. (In one particularly enthusiastic moment, during a joint conference between surgeons and radiologists to address such issues, I dis-ingratiated myself by saying, "When all you have is a hammer, everything starts to look like a nail.") I tried -- ultimately unsuccessfully, I'll sadly admit -- to convince primary docs that when they could feel a lump, the first stop ought to be at the surgeon's, not the radiologist's store.

A breast lump is either solid or liquid. For the most part, that's all an ultrasound can tell you for sure. At considerably less than half the price, a surgical consult with needle aspirate will give you that, and much much more. Poke a fine needle (size of one used to draw blood) into a lump: if it's liquid it's nearly always a harmless cyst, in which case the needle withdraws yellow clear fluid, proving the diagnosis and making the cyst go away, usually permanently. Same info as the ultrasound, along with therapy. If the lump is solid, the needle can remove a tiny sample, which, properly spread on a slide and given to a pathologist skilled in such things, can be very accurately assessed. When a lump is cancer, the needle sample either shows cancer, or some cells that are highly suspicious. And when the sample shows entirely innocent cells, and when the lump in question is clinically innocent (as judged by a competent examiner), the chance of missing cancer is extremely low, in which case followup without further biopsy is often a satisfactory option. Few things -- medically speaking -- bug me more than seeing a woman who's had an ultrasound that shows a cyst, referred for treatment. Had it been the other way around, the ultrasound would have never been needed. Even worse is a woman who had a palpable lump, sent first to radiology and getting a mammogram followed by an xray guided (stereotactic) biopsy. Huge waste of time and money. (I may post about diagnostic issues again and get back to this. For now, suffice it to say that stereotactic biopsy is an excellent tool for a NON-palpable lump. And, along similar lines, I'd say this: a mammogram is to find things we can't feel. When a lump is feelable, it makes more sense to me to see the surgeon first: for example, if it's a cyst, and I drain it, what's the good of having taken a picture? It'll be gone on the next one!..... It could take several posts -- or a hellaciously long one, to cover this well.)

So here's the drill: if I saw a lump, I'd generally poke a needle in it. Takes literally about five seconds, hardly hurts. If I'd get clear yellow fluid, and if the lump went away completely, I'd tell the woman with total confidence that it was a simple cyst, explain exactly what that means, arrange followup, and flush the fluid. (It used to be routine to send the fluid to the lab. But several studies confirmed what I'd come to believe: if clear yellow, and associated with a disappeared lump, the tests never showed a thing. So tossing it away became the marching order.) If the lump was solid, I'd sample it with the needle, make a slide, and send or carry it to the pathologist. And when I was sure it was cancer, the sample virtually always showed it. I'm efficient as hell, with a woman's time, and money. But I got two surprises in one week, and they were close to disastrous.

When I saw the referral came from a family doc who always used someone else, I thought this was gonna be something strange, and indeed it was. She'd done a needle aspirate (good for her!) on a young woman with a lump, had gotten clear yellow fluid, observed the disappearance of the lump, but sent the fluid to the lab. And had gotten back the diagnosis: cancer. I was stunned, and deeply disturbed. It was against everything I believed: I'd tossed tens of hundreds of fluid sample into the trash. How could this be? I called the lab, I talked to the lab doc. Was there any chance of an error, a mixup of labels, anything to explain it? There was not. I asked them to double check. They did; there was not. When I examined the woman, the site of the needle poke wasn't visible, and there were no lumps. The doc couldn't say with precision where the lump had been. The mammogram was normal as could be (she was young enough -- early thirties -- that mammograms aren't all that useful, anyway.) Just to make it all more interesting, she was an attorney in the DA's office. To say it was disquieting is to understate by a factor of a pants-full. The woman evidently had cancer, despite the diagnosis being counter to a fundamental principle of my practice. In fact, I already had reason to question my whole approach: I'd just done a needle aspirate on a little old lady who I was absolutely convinced had cancer, and it had come back totally innocent. I must have missed the lump by a mile: me, who made a crusade about the method. Not even my fellow surgeons used it as much as I did. I'd had to do a more expensive, more invasive open biopsy on the lady to confirm the diagnosis of cancer...

Getting goose-bumps yet? It all became clear, about a day or two after I operated on the young attorney. I'd removed the entire quadrant of the breast in which the "cyst" had been, and had done a small lymph-node sampling under her arm. The good news is that because the breast (properly managed, if I may say so) can end up with very satisfactory contour after a pretty large lumpectomy, she got a nice cosmetic result, other than a fine scar. The pathology report, which showed absolutely nothing out of the ordinary, came about the same time I got a phone call: they'd pursued it further and discovered a lab mixup: the slide made from the cyst fluid, and the slide I'd made from the little old lady had been confused by the lab. They even acknowledged that mine had -- as always -- arrived from my office properly labeled and marked and that the error was entirely theirs. Without being asked, the lab doc sent a letter to my patient explaining exactly what had happened, and that I'd twice asked them to double-check. She was surprisingly gracious. And my little old lady, who indeed had cancer, did well despite having undergone an unnecessary open biopsy before her definitive treatment.

And here's the thing: these aren't even the worst stories. I once did a biopsy on a lymph node under the arm of a woman in her seventies. Metastatic breast cancer, was the report. No ifs, ands, or buts. The mammogram, the physical exam were normal. It's uncommon but not entirely rare, and the concensus is that the treatment is mastectomy on the affected side, with around a 60% incidence of finding the cancer in the removed tissues. I was in the recovery room writing post-op orders, having done just that, when I got a call from the pathologist. "Hey Sid, this is Dave. Just got the report from the university. Remember that lymph node? They said it was melanoma. Guess it's lucky we waited, huh?" "WAITED!!!! WHAT THE F--- ARE YOU TALKING ABOUT???? I just took her breast off!!" "Jesus," Dave said. What happened is, they have a weekly cancer pathology conference, at which -- after the final and unequivocal report had been sent out -- another pathologist (he's the one to whom I always carried my breast aspirates -- the best I've ever seen. He was out of town during the week of the first two cases...) had said he thought it might be melanoma. They'd decided to send the slides for consultation, but hadn't bothered to let me know... I said "Dave, you are coming with me when I talk to the lady." Dave said..... well, I don't remember what he said. But he came.

What's the lesson here? Damned if I know. I was inspired to write this after reading the latest post at Urostream. If good news isn't always good news, and bad news isn't always bad, I guess you have to hope to hell you have a team that talks to each other.

36 comments:

thats mildly disturbing...lab mix ups and lack of communication, oh my!i work front desk now, but since i got done with medical assistant school i worked in a dematology clinic for about 8 months, and the did lots of temping. while at the derm clinic, we had a temp come in for a week. she was awful. we did lots of biopsies, and they had to be clearly, proerly labled, and done so in timely fashion. she didnt do that. at the infectious disease clinic i work at now, we send people for blood work all the time. in one case recently, at a lab we dont use often, a blood sample was left on the counter all day because a snippy lab tech didnt believe they could do the test requested. it was a test routinely done by our usual lab. of course, the sample was completey ruined, and the draw had to be repeated, and the pt lived miles out of town...and our nurse was furious. not as bad as your stories, but still, there has to be absolute accuracy and efficiency in these things, because they involve a persons time, money, and most of all well being. i cant belive there can be such mix-ups likw these. 'the devil is in the details'.

In the end, it's all about the honesty. The honesty to admit a mistake when it happens. The honesty to realize that everyone one is fallible, that if I become excessively angry at someone else's fallibility, I will sooner or later have to answer for my own.

When you get a lab result that's so different from what your clinical experience indicates, is it maybe a good idea to repeat the lab test, when that's possible? (Not sure what you'd do about the aspirated-and-disappeared cyst.) And maybe it's also a good idea for physicians as well as patients to ask for a second opinion, ideally on a new specimen or on both a new and the original.

Holy moly, though. Ow. As I've visited a couple of local labs for services in the past few years, and noticed how chronically understaffed they are, I get even more nervous about relying on them.

I am in kingston jamaica and my email is naudia_wrightthomas@yahoo.com. I have just 2 days ago discovered that there is a yellow liquid coming from my right breast and I am scared. I am going to the doctor today. However, based on your article, please tell me what the first step is.

I have a question...I have a breast lump...located directed under a familial mole. Finally, got someone to listen to me...as the OB/GYN ruled at first had to be skin/mole related...Dermatologist ruled Breast related, and was going to shave it off....Mammogram and sonogram findings have lump at BIRADS 4. Biopsy and lumpectomy are Thursday. What should I be looking for from the surgeon? Is removing this and the surrounding tissue, the right course? Should there be a more aggressive treatment? And finally, could this be a totally freaky benign situation?Thanks Heather...

Heather, I'll post here the response I sent you in reply to your email:

It will all depend on what the biopsy shows. All you have learned from the studies so far is what you already knew: there's a lump. It will be getting a tissue diagnosis, which is appropriate. It could be benign, in which case it wouldn't need "aggressive" treatment. If it were to turn out to be cancer, then there are various options which, I'm sure, would be discussed thoroughly.

Dr. Sid:I'm a pastor, so I'm into a different therapy. But, I'm a huge fan of surgeons. They have created an airway for my 11 year-old who - at one time - had a completely occluded trachea due to acquired subglottic stenosis (premature birth and subsequent ventilation at 29 weeks gestation) and lived with a trach for 5 years.Anyway... prayed for a woman with two masses in her breast. Diagnosis came from routine mamogram. One was clearly a large cyst. The other was solid. The gyn decided to wait for 6 months. Then, suddenly called back and referred to surgery. On the Monday following the Thursday of diagnosis, the surgeon recommended ultrasound and biopsy. The technician immediately found the cyst and confirmed but could not find the other mass. The radiologist had the same result after tons of manipulation and looking. Final diagnosis... nothing to diagnose.I obviously want this to be a supernatural event. What other questions do I have to ask to be honest about that? I guess that repeated compression of a cyst could easily cause rupture and disappearance. Could the original diagnosis of solid mass be mistaken? Thanks!Pastor Dave

Pastor Dave: cysts often come and go. As to a "mass," it's a matter of interpretation: mammograms show all sorts of densities, the interpretation of which can be subjective. "Mass" is nearly a meaningless term, out of context.

I've seen many a mammogram that was over-read by one radiologist or another (better that than under-read), and have seen many shadows present at one time and not at another. This is especially true in women who are younger than menopause.

And I've had several patients show up for an xray-guided biopsy, for "something" not palpable that showed on xray, only to be told it was no longer there. It happens. I'm sure some of them were praying. They were also going through normal hormone cycles.

One of my constant struggles was advising women who'd had a mammogram interpreted as a "mass" when I considered it just asymmetrical density, common in lots of women, especially those with fibrocystic changes. Not a comfortable or easy situation.

Here's a comment I just received. I'm reprinting it to remove the email address:

I hope that I am finding this helpful and informative. I am not quite sure what to do and no one seems to know. I have a small limp that is rather superficial (but so are my breasts, I do not fill most A's) I first noticed it months ago, probably last summer. It was a dark spot that just wasn't quite the color of a mole or freckle. It is a dark, blackish sometimes slightly bluish lump just under the skin. I have mostly ignored it but decided maybe I should get it looked at before I switch insurance. The NP thinks it is likely nothing to be concerned about but ordered a diagnostic mammogram and ultrasound just in case. I asked if was really necessary if she really doesn't think it is anything to worry about. She said that they have been fooled before so she still thinks I should do the tests. Probably naturally I have been paying a lot of attention to the spot-lump since. Though the discoloration is always there the lump is virtually non-exisitant in the mornings. It is very round in shape and depending on the time of day probably 3/10 to just under 1/2centimeter in diameter. In your oppinion is a mammogram and/or diagnostic ultrasound the best course of action (though your opinion seems clear)? Could it be related to a blood vessel? and if you think it would be best to do the needle prick thing how do I go about discussing or explaining and/or requesting this to the Dr. / NP?I would so appreciate your professional advice and oppinion. I have found no information about anything like this little spot-lump. Money is an issue as I am changing from a high deductable insurance plan to an even higher deductable plan. I really don't want to spend a ton of money on satisfying curiosity. Oh and I am 32 years old so it sounds as though a mammogram might be moot anyway. You can contact me by e-mail at (----) and though I don't mind this being published on your blog I would prefer that my e-mail not be out there. thanks so much.

It could well be a cyst, and, as I've described in my writings here, my approach with most masses was to insert a needle as a first step: if it's a cyst, it will disappear along with the return of some clear yellow fluid. If it's not a cyst, the needle will usually provide a small sample of the tissue that can be analyzed under a microscope.

I agree mammography isn't very likely to help with the item you're describing, but that's not to say a mammogram is not indicated.

Finally, I can only provide general information about my approach; there's no way for me to have enough specific knowledge of an individual situation to provide direct advice. It must be, and can only be, between you and your doctors.

But do you have any advice on how I could or should bring up checking it the way you would (with just a needle) ti my Dr? It was never mentioned at my appointment and does not seem to be a common practice. I somehow happened apon your blog otherwise I'd not be aware that was a possiblity (though I had even mentioned to my husband that I think they should just stick a needle in it and see what they get, it seems more common sense after reading your blog) I would like to opt for trying something like that first but I am not sure how I would suggest this. What would I call it? How would I get them to take me serious and consider it? My experience has been that Dr.'s seem to get set in certian methods and ways and do not like to be told otherwise by a mere patient. (from this blog entry it would seem they don't even like to listen to educated knowledgable surgeons, you, either)Do I just tell them this is what I want them to do first? And if there is resistance or the look, then what would you suggest?I know that you can not give me a medical diagnoses or anything but I would like your advice. My description was hoping that you had experience or knowledge of spot-lumps of this kind. Though you being a sergeon and not having seen anything like it would be very encouraging.Again any advice would be so appreciated.P.S. your blog is pretty cool thanks for sharing.

I'm sorry not to be of more help, but I think I've said all I have to say without feeling like I'm intervening between you and your doctor. Needle aspiration of breast cysts and other lumps is not uncommon and I'd think you could say you've read about it and wonder if it would apply to your situation. Beyond that, I think you have to decide if you're comfortable with the explanations you receive: I repeat that the interaction between you and those who know you is much more trustworthy than those with someone on the other side of your computer screen.

36 yr old Femalepalpable tender lump 9:00 rt breastmammogram - negativeultrasound reveals a subtle, approx. 1.6cm area of mildly hypoechoic apparent architectural distortion. Assessment: BIRAD 4CNB- Benign. Fibroadenomatoid and fibrocystic change. Radiologist recommends excision or contrast MRI. OB/GYN says she wants it out, and I would like it out as well. QUESTION: Is there a significant difference between fibroadenoma and fibroadenomatoid? Should I be worried about a "missed" cancer in this case?

Jennifer E: I'm not sure I've seen the word "fibroadenomatoid" in an xray report, or even heard the word before, but I'd assume it's sort of a fudge, meaning fibroadenoma-like. Benign, in other words. But I can't know for sure: if it would make a difference in your decision-making, you should ask your doctor to clarify or get a clarification from the radiologist.

Great. I haven't been able to find much on the internet regarding fibroadenomatoid, except "fibroadenomatoid hyperplasia." I'm going to assume for now that it's just like you said - similar to fibroadenoma. Thank you for your response. I'll ask the surgeon on Monday.

Hi, I'm not sure if you're still actively checking this blog but I'd like to ask - if the doctor finds a solid lump and says it's benign after checking my breast ultrasound results, should I still be worried on having it removed?.. Other than surgery, is there another option of having it removed? I think I saw somewhere about using something like cryotherapy? What are your thoughts on this? Thanks in advance.

As I wrote, it's my opinion that ultrasound can't definitively determine whether a solid lump is benign or not. As I also wrote, my usual approach to a lump that's palpable was to insert a fine needle into it: if it's a cyst, you get fluid and the lump goes away. If it's solid, you get a tissue sample which can be looked at microscopically, which gives useful information. If the cell sample is benign and all else suggests it's benign, and if the woman prefers not to have it removed, I considered it safe, in many (but not all) circumstances to leave it alone; but I also recommended close follow for several months. I'd not recommend (and I doubt anyone would provide) cryotherapy without having a tissue diagnosis. Nor was it my practice, if there's not a definitive diagnosis, to consider a lump "done" based on ultrasound. In my opinion, any discrete lump needs either a diagnosis by some form of biopsy, or a plan of careful followup.

How to handle a particular lump, though, in a particular person, depends on many more bits of info than you provided: age, hormone status, family history, the "feel" of the lump, mammogram findings (if indicated), etc. So all I can do is give general information and describe, in very incomplete fashion, my general approach. I have no way of offering specific advice to you about your particular lump. You need to go with your doctors' advice, your own comfort level, and/or get a second opinion if you're not sure about things.

Reading this is reassuring. I had mastitis and now have a lump under my nipple. I've had a sonogram and mammogram. The radiologist told me to come back in three to six months. My doctor then sent me to a surgeon who did a fba. He showed me yellow fluid that he extracted and sent it to be tested. I will get the results tomorrow and am so scared. The lump has gotten smaller since the fna but is still there. Any feedback will be appreciated.

Sounds like you're getting good care. And when yellow fluid is aspirated from a lump, that's generally a very strong sign of a benign process. It's nicest when the lump completely disappears, but that's usually what happens with a simple cyst. Having had mastitis, there'd still be some residual inflammation, which could take a while fully to resolve. Those are, of course, general comments; from here I can't really be specific to your situation.

The main thing is to have a plan for followup. Meanwhile, I think it's appropriate to relax some!

I found this blog while searching for any info on FNA. I'm 41,2 kids, no history of breast cancer in the family, non-smoker and have a large lump under and around my right breast. I have pain and an inverted nipple due to the mass. The lump doesn't seem fixed, has smooth edges and I only have dimpling if I squeeze the skin around the lumpy breast, so hoping not likely to be the big C. I had a FNA this week,told no fluid came out but they will send it to pathology anyway, have to wait a week for results. I have to go back for a mammogram, ultrasound and biopsy next week. I'm no surgeon, but I wish they had done as your blog recommends - straight to the surgeon. (Mind you, I live in England and the national health service probably go to the surgeon as a last resort, I expect it costs more than all the tests. If this turns out to be nothing, I'm taking out private health care. Here's hoping it's nothing.)

This is an interesting and refreshing post. I have a little story too. I had a needle biopsy in the area where I thought I had cancer. They took the fluid, said it was yellow, said the cyst was gone and I was good to go. It took me three more months to get a prophylactic mastectomy, which they didn't expect to find anything, and guess what. In the area where they did the needle biopsy, was a 2.3cm ILC. Maybe I had a cyst and ILC. Invasive lobular cancer is hard to see on imaging (as I know because I had 2 mammos, 2 ultrasound, 1 MRI and no results indicating the cancer). I guess I'm lucky, but I'll always wonder, if they had listened to me when I asked them to send the fluid to the lab... would they have found cancer earlier??? hmmm.

I had a very vascular lump under my armpit about a year ago that was Birads 3 and slowly went away about 6 months ago according to ultrasound. Now it has returned and I went in for an aspiration today which turned into a biopsy as the fluid was thick. The doctor described it to me as being either "very thick liquid or very mushy tissue". I also have a slight rash on the corresponding breast that my doctor (a breast specialist) said not to worry about. I can't help but to worry.

I understand the worry that comes from not knowing, but I assume you'll be getting a report soon on the material that was aspirated. Your doctor is a breast specialist so it sounds like you're in good hands.

Hi! Awesome and informative blog. Well, I found a palpable lump in my right breast above my nipple in Dec 2016. It is quite movable and I can shift it around (and it did not really bother me only noticed it because it was close to my cycle) Two weeks later I had a diagnostic mammogram and ultrasound done and I was told that day it was a simple cyst. I also received a letter from the hospital stating that everything was normal with my mammogram (even though this lump was there) and that I did not need to have a mammogram again until the recommended age of 40. A report was sent to My doctor within 48 hours after the mammogram and ultrasound and she informed me that she did not see a need to aspirate the cyst. However, since the mammogram and ultrasound I get a dull ache in my right shoulder blade, shoulder and down my right arm. I did not notice this until after the mammogram and ultrasound. Should I be concerned? Should I push for an aspiration, or just get a second opinion from someone else. Oh, I am 37 and no known family history of breast cancer. Please let me know your thoughts.

Sleepless: As you read in the opening of this post, my approach to a situation like yours was to aspirate when I first saw the woman. (Of course, it was often the case that, as a surgeon, the patient had been sent to me by her primary care doc, which is a little different from where you stand.) As I wrote, my reasons were that it not only made the definitive diagnosis, making ultrasound unneeded but made the cyst (assuming that's what it was) go away. I never saw the need for ultrasound for a lump that was so easily palpable.

At this point it seems the nature of the lump is clear, so the main reason to aspirate it is to relieve discomfort; either from the lump itself or from worrying about it. They can be tender. I guess it's possible it's the cause of the pain you describe.

Timing of mammograms, as you seem to know, is controversial. Absent family history or specific indications, changes of concern, it's certainly a common recommendation to not begin routine mammography before 40. In part that's because in younger women breast tissue is often so dense that the images aren't as easily interpreted. Your doc should be able to let you know if that's an issue in your case. In the end, for routine mammography, given the fluidity of recommendations, I think it's a matter of your own comfort and preference, after talking over the pros and cons with your doc.

Thank you so much for your reply back!! Your reply gives me some comfort. Yes, I do want it aspirated to just ease my mind and sent for testing. When I first felt it in Dec. and went to the doctor it was painless, and the DR. thought it could be a fibroadenoma prior to the mammo and U/S. Now it feels a little tender (may be due to me checking it regularly) and hasn't reduced in size (I don't think). Unfortunately, I googled too much online and it has made me worry so much about being misdiagnosed because of all of the stories. So I made an appointment to speak with my primary doctor regarding the pain radiating down my arm and in my upper back especially since the lump is still there. I am wondering if it also has anything to do with me ovulating or the two cups of coffee I drank Sunday, and ALLLLL of the chocolate I ate over the weekend (I am laying off of the chocolate and coffee going forward). lol! Nevertheless, I have an appointment scheduled for this Thursday with hopes of aspiration.

For the record, as I also wrote, if aspiration returns clear yellow fluid and the lump completely disappears, "testing" the fluid is so unlikely to show anything unexpected that I never did it. Which is relevant to one of the "tales" in this post, too.

Hi! So I saw my primary doctor today and she explained to me more about how accurate ultrasounds are and that if the radiologist said that it was a simple cyst, it is just that a simple cyst and that if something more was there it would have been seen(I also had the 3D mammogram). She does not do aspirations, but referred me to a breast surgeon to get a second opinion, which I will see in two weeks. That does make me feel more comfortable and then she told me to stay off of google and stop scaring myself. lol! It's one thing to educate yourself, but its another thing to become consumed with all of the stuff that happens to other people. She is also sending me for a bilateral tests for my arms (and I think of my spine) after I explained to her the dull aches in my back because I am actually feeling dull achiness in different parts of my body at different times throughout the day. She looked in my notes and saw were I complained several months ago about issues with my tailbone hurting and it feeling like a pinched nerve in my right leg for a moment as I stood up from the chair at work. I say all that to say, that the achy back is probably separate from the cyst, its just so happens that everything happens to be on the right side of my body (I am right handed too). Also, noticed today that I felt some achiness on the left side of my upper back as well while sitting at work. Could be an ergonomic issue. The itchy armpits and skin may also be just from dry skin and shaving too (its cold where I am)....so maybe she is right about staying off of Google :) Just wanted to give an update.

I have a question. I had a fine needle aspiration done on a lump in my breast. Was quick and easy. But I bled a lot. The assistant asked if I was on blood thinners, I said no. Well, she got it to stop bleeding. Sent me on my way. Report came back benign. Anywho, the bruising was significant and it felt hardish under the bruise. I called the doctor. Said that was strange. Was told that the bruising/hematoma would take a while to disappear. Hot compresses, etc. After doing this for a bit, I discovered that I had pain. Of course on a Friday night I felt it was hot. I went into my PCP Saturday morning as the surgeon was closed, she said looks infected. Gave me antibiotics. Now has been nine days and it has really gotten 90% better. There is still a small lump there, though. Used to be a huge lump that I thought was a hematoma. I guess back to the surgeon? Or do these things happen and it will take time to heal? I'm 23 days out. Have you ever heard of something like this?

It's certainly a known possibility that a needle aspiration can cause a hematoma, and that they can take a few weeks to resolve fully. It's also possible for a hematoma to become infected. If that happens, it's more likely than not that it'd need to be surgically drained.

Those are general comments. I have no way to know if your situation represents a hematoma and whether it is or was infected. Best to direct your questions to the surgeon.

About Me

Boring, Unoriginal, but Important Disclaimer:

What I say here is as true as I can make it, based on my experience as a surgeon. Still, in no way is it intended as specific medical advice for any condition. For that, you need to consult your own doctors, who actually know you. I hope you'll find things of interest and amusement here; maybe useful information. But please, please, PLEASE understand: this blog ought not be used in any way to provide the reader with ideas about diagnosis or treatment of any symptoms or disease. Also, as you'd expect, when I describe patients, I've changed many personal details: age, sex, occupation -- enough to make them into no one you might actually know. Thanks, and enjoy the blog.